1. Have you seen your Dr. for a physical examination (including Pap smear) in the past 12-months)?

a. Yes
b. No

2. Are you using any form of contraceptive that could prevent pregnancy (condoms, spermacides, etc)

        a. Yes
        b. No
 

3. Which of the following supplements do you take:

a. Dr.prescribed prenatal vitamin
b. Store-brand prenatal vitamin
c. Daily multivitamin (ex: Centrum)
d. No vitamin supplements

4. Which of the following best describes the frequency of intercourse during your cycle:

a. Every 48 hours when observing fertile cervical mucous
b. Every 24 hours when observing fertile cervical mucous
c. Every day.
d. I am not observing cervical mucous to time intercourse

5. Which of the following are you doing to determine when you are ovulating?

a. Observing cervical mucous
b. Checking cervical position
c. Charting your basal body temperature
d. Using ovulation predictor kits
e. All of the above
f.  None of the above

6. Check all that apply to your husband:

• He avoids hot tubs and saunas
• He wears boxers instead of briefs
• He avoids recreational drugs and alcohol
• He exercises regularly
• He eats a well-balanced, healthy diet
• He avoids excessive use of caffeine

7. Check all that apply to you:

• You exercise regularly
• You are close to your ideal weight
• You eat a well-balanced, healthy diet
• You take at least 400 mcg of folic acid daily
• You have had your Rubella (measles) immune status checked by your Dr.
• You avoid artificial sweeteners
• You avoid excessive use of caffeine
• You wait at least 20 minutes after intercourse before standing up
   

8. How many hours sleep do you get per night?

a. 8
b. 6
c. 4
d. I have insomnia

9. My Luteal phase is 14 days?

a. Yes
b. No

10. For lubrication during intercourse, do you use:

a. K-Y Jelly
b. PreSeed
c. Egg-whites
d. Nothing

11. When having intercourse, which position do you use:

a. Missionary (man on top)
b. Rear-entry ("doggie-style")
c. Woman on top
d. Side-by-side
e. Other

Your Score

45- 60 points "Fertile Myrtle" - Good for you! Conception and healthy pregnancy are very likely!!